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� ,.�..�...� <br /> APPLICATI�.� RO�i CONSTRUC�.�N PERMIT ''�,'"'" � <br /> �T�,�,A TO BE COMPLETED IN INK—PLEASE PRINT � N <br /> � m.�G�ey�nan <br /> ❑IV Vr <br /> I everett — _ _ .� <br /> I HEATING SYSTEM: ' GAS �J ELECTRIC iJ __ __ __ <br /> BUtLDWG DEPARTMENT L---- — —— --��— —� <br /> 259-8810 <br /> � �+ DEMOLITION xCOMBINATION _ _ BUILDING _ MECHANICAL PLUMBING S'GN <br /> NER � MP11�O�RE55 CI Y 4P PHONE <br /> o� � i"�� �F���(n �i. � ° ' � � (�Fi�� �l�A r�i���«�o,1��A 9Q2��; �"��G 10 — <br /> C`G II yn <br /> M IE NT M/�LFOORESS LITY ZIP PMONE <br /> C'�� N II — <br /> �' CHITECLOROE�IS'iNER MMLA�ORE55 yIiV ZIP PNONE <br /> .� o � s �c ,-ni �-.' p � _ F�I�kJl�O V'✓�t �1�6r�7`� � n _ <br /> QER4LLONTHACIOR MNRAODRESS CIiY ZIF VHONE LIGENSEN <br /> ��� �AEiF F}5 iNf k'- ���=�`��l�v <br /> MF XAN�CnLCI RFCTOR ILAD�RESS CItV ZIG PHON' LICENSEp <br /> ��� � � � �1�� , - �ru�T�k: a"]'l,t� ��L�" �iU�rJ� ����=�t,�, ����E it����� ����E/��� �S�I�z'��ti�r�'� <br /> � e�g P a����.�. �ro ��M��AooREs�� ��o. ill4(�fA��rt�.iZ F �XYiKit�����'�' r��rfl�� �iG�2� 7�, �, <br /> o� i �1 c l � ' , nl �- r�f �KIVEYl'PI� <br /> (a' y (� CLFSSJFWOFx . <br /> C3� �NEW ADDITION ALTERATION REPAIR � DEMOLITION WOODSTOVE/FRPL INSERT . BUILDING RELOCATION <br /> �yj[� � � �W '/ �S+� CONT�GT PER50 AN PHONE NO. <br /> � � �����T <br /> N H CONTRnC��RICE OF WORN <br /> � �E�R�BEWQH ANDSQUAREF TAGEINVOLVEO <br /> N <br /> ��� � h�"' � . <br /> t+ P oseouseocaw ,� SFR� � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS <br /> y L`+ntl _�< APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> H O G7 iecni oescAmnor�oF Paoaearv�sNowrv eE�owoa nnnc�+Fouacoaies� PROVISIONS OF LAWS AND ORf11NANCES GOVERNING THIS TVPE OP <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or eiocrc oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO C�IVE <br /> AUTHORITV TO VIOIATE OR CANCEL THE PFOVISIONS OF ANY <br /> OTNER STATE OF LOCAL lAW REGULATING CONSTRUCTION OF THE <br /> pi 'y��erpyu�d �d brtlwrt a�«•�•e ee. s..a..•e a.«•��� PERFORMA�CE OF CONSTRUCtION.THAT I AM AUTHOR¢ED BV THE <br /> S�aetw]I. To+e��y 2! bre�. bni� S 4�0. Y.11. l)fel�e�! �It��+�lc� <br /> L M���< <°'"� ��`�^°�T '�'0 Vj0°� �'�° !m�ot ��ta nevuuue OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH <br /> ��re�r�� ra,m,�o,,,,c �..s�.r ane b�ea suam at ee.swm vm.ee enm APPLICATION IS MApE AND i COMPLV WITH THE STATE <br /> t�ewe u nuy�a xa �a�•vw M � u�^'i°°• '"'t'�Nl `°`o°`•°ie., CONTRACTORS LAW 18.D RCW AND 296200 WAC. <br /> M����p��j ]j� {gll, �n\o{oe.� �IO et Meda. pp �_. ���Audttor'f lLL� SIGNATUREOF W ACTORORAUTHORIZEDAGENT DATE <br /> F. U11�t: QCR[ tM veu N� N�t !�e rtv��c; A6D tIC[6 N�hsW IIO [we <br /> el tM Y�a 21i!nt e! eM un� ]O3 fnt N�vmf. ' X <br /> aaa c*nooness ,�t/ � ` //-3O 9/ <br /> L ;/ y�'L' � qPPLICANTSCITYBU51NES5LICENSENO NNDBU5ME5SNhME <br /> � <br /> PLU BING MECHANICAL <br /> NO. 7VPE OF FiXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NG—NHNDLG UNITS—H.P. <br /> °�� � 3 BATHTUB S ; — FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> � 3 LAVATORV(W9SH BASIN) UNIT HEATERS—B.T.LL M <br /> � � SHOWER _ CLOTHES DRVERS <br /> . �� KITCHEN SINK&DISP — VENTILATION FAN <br /> ' DISHWASHER _ RANGEHOOD <br /> LAUNDRYTRAY WATER HEATER <br /> � CLOTHES WASHER WOOD STOVE <br /> �� 1__,, � � URINAL / ' METAL FIREPLACE&CH!MNEV <br /> ' ��4 ORINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> � � BACKFLOW PREVENTERS GAS PIPING <br /> ' � ROOF DRAINS—RAINLEADERS EXHAUST FAN �� <br /> ' �� SINK(SERVICE—BAR,ETC.) oo.�J'i U �oo <br /> i <br /> I �'� — — <br /> � I SUB Tq7Al $ ,] I -- SUB TOTAL $ —" <br /> I PERMIT $ T— PE7MIT $ � <br /> ��� . TOTAL FEE $ d= TOTAL FEE $ o ' � <br /> FOR OFFICE USE ONLY: ' <br /> -- - FRONTSEiBFCK REFRSET9ACK / SIOESETB�CH PLANCHEf,KNOMBER FEE RECEIPTNO. <br /> Z:, ' ' ���°P -5 ii a� ?v � v�sss. �� s-� yz <br /> use zo�� �oT nr+en 3 7 92 vnc�ar�(*srtE FEES VALUA71 FEE <br /> _' � �I/ JQ�F" ( �S BUILDWG �jS S�7Ce ' �D <br /> lVGfO�CONfSnLLOWNBIE iYPEOVGONS�NLiUFL o¢uP>xr,r Fno�owe:arvaurvil5 i <br /> �nu� 1 pLUMBING �p �� D C� <br /> ��� -i.r Q 3 <br /> SiZE oi B�Ua rvO.OF SroaiES � BASEMEr+T MECHANICAL <br /> 1",_,(e1 54 Fi + .` �J r D � 0 0 <br /> 5 AODITIONALPLANCMEGK � yG ' 9 <br /> OLCOPANCY LOAD FlFE SPRNNLERS NEO'D MEIGHT LIMITPTION <br /> No _ ._ orHea ' <br /> RE�ISONF RSPRMK�ERS � <br /> STATE BWLDING SURC4ARGE __� ,,� <br /> irv�nke ev ainNs navvoveo ev CITY OF EVERETT PUeuC woaKs p I O o <br /> �^� lJ,,�/ LOCAI SALES <br /> 7 !� 2�26 TAX CODE IS 31Q5 TOTAL �� � �g/ <br />